Accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid.
Although benign, it may enlarge and invade adjacent bone.
Often presents with a malodorous ear discharge with associated hearing loss.
Diagnosis is clinical based on history and otoscopic findings. CT scan provides lesion definition and extent.
Treatment is surgical removal. Adjunctive topical antimicrobial treatment may help reduce acute symptoms preoperatively.
Complications include recurrence, meningitis, facial palsy, and a labyrinthine fistula.
Cholesteatoma is defined as the presence of keratinizing squamous epithelium within the middle ear, or in other pneumatized areas of the temporal bone.  This keratinizing epithelium exhibits independent growth, leading to expansion and to resorption of underlying bone.  Focal erosion of external canal bone with accumulation of keratin is called external canal cholesteatoma. 
Consultant Otolaryngologist and Otologist
Rotherham NHS Foundation Trust
SAD declares that she has no competing interests.
Professor and Vice Chairman of Otolaryngology
Case Western Reserve University School of Medicine
CM is an author of a reference cited in this monograph.
Senior Lecturer in Otolaryngology
Honorary Consultant Otolaryngologist
Glasgow Royal Infirmary
IS declares that he has no competing interests.
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